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BCG Vaccine

  • We use the only BCG vaccine licensed in the UK which is “BCG Vaccine AJV” made in Denmark.  See the Package leaflet: Information for the user here.
  • “BCG Vaccine AJV” is approved to be used by the NHS and supplied to us by the same supplier to the NHS.
Cost of BCG vaccination including consultation – There are TWO options:
1) BCG given during monthly clinic: £75 payable when booking the appointment over the phone.  Our next monthly BCG clinic will run on Saturday 1 Feb 2020.
2) BCG given outside scheduled clinic: £100 payable at your appointment: “usually Mon-Fri: 17:30 to 18:30 & Saturdays 09:00 to 15:00″.
To book an appointment please call 020 7435 7075.

Evidence of no previous exposure to TB prior to BCG is required for some individuals (e.g. anyone 6 year of age and over; see list of people require TB skin testing below)

TB screening test (the Mantoux test): £70

The £70 fee for TB screening test does not include the fee for BCG vaccination

Two appointments required: one to administer the test and a second one to interpret the results 48-72 hours after; if negative, BCG can be given right after in the same appointment

Other vaccines can be given at any time before or after BCG.  However, no further vaccination should be given in the arm used for BCG vaccination for at least 3 months.

Please read this leaflet before the appointment: BCG Vaccine: After Care for Parent

For more information email: info@hhpharmacy.co.uk

A message from the Mayor of London’s TB Ambassador Emma Thompson and her son Tindy on World TB Day

BCG Vaccination (TB vaccine)

Bacille Calmette-Guérin (BCG) vaccination is recommended when a child or adult is thought to have an increased risk of coming into contact with TB. The available BCG vaccine is safe, effective and remains the cornerstone of TB prevention.

There is consensus that BCG vaccination of infants provides protection against disseminated TB disease (TB which spreads from lungs to other parts of the body), TB meningitis and death. Surprisingly however, the efficacy of BCG in preventing adult pulmonary TB (TB that affects the lungs) is often still denied despite a sizeable and increasing body of good quality evidence to the contrary.  Good quality evidence supports the efficacy of BCG vaccination in the prevention of adult pulmonary TB. For more information see this paper: https://www.ijidonline.com/article/S1201-9712(19)30100-6/fulltext

If BCG vaccine cannot be given at birth, it should be given at the earliest opportunity thereafter and should not be delayed, in order to protect the child before exposure to infection occurs (WHO Position Paper on BCG vaccine, 2018)

What is TB?

TB is a bacterial infection. Anyone can catch TB by breathing in the bacteria that cause it. TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. A person with TB can die if they do not get treatment.

Who should be offered BCG vaccination?

National Institute for Health and Care Excellence  (NICE) recommends that BCG vaccination should be offered to:

1) newborn babies if:

  • they were born in an area where rates of TB are high [such as London]

  • 1 or more of their parents or grandparents were born in a country where TB is widespread 

  • someone in their family has had TB in the past 5 year

2) children who are 15 or under who weren’t vaccinated as newborn babies and who may be at higher risk of TB

3) people who are 35 or under who haven’t been vaccinated before and have had a negative Mantoux test result if they:

  • have been in close contact with someone with TB affecting their lungs or larynx
  • have come to live in the UK from areas where TB is widespread
  • work with animals that can get TB (such as chimpanzees or cows)
  • work in prisons, homes for older people, or hostels for refugees, asylum seekers or homeless people
  • plan to live or work for more than 3 months in a country where TB is widespread

4) people who haven’t been vaccinated before and have had a negative Mantoux test and work regularly with patients or clinical specimens.

The burden of TB in London

TB is a significant public health challenge in London. The city accounts for almost 40 per cent of all cases of TB in England, and one third of London boroughs are classed as high incidence by the World Health Organisation. This means that some parts of London have TB rates comparable with countries such as Algeria and Iraq. For over a decade, London has had the dubious title of ‘TB capital of Western Europe’.

The London areas with annual TB rate higher than total London average includes (descending order): Newham, Brent, Ealing, Redbridge, Hounslow, Harrow, Barking & Dagenham, Waltham Forest, Hillingdon, Tower Hamlets, Greenwich and Hackney.  However, because of large cross-boundary movements in London, universal neonatal vaccination is in place across all London areas.

 

Three-year average number of people with TB and rates in London 2016 to 2018

Local authority Average annual number of people Average annual rate
per 100,000
Newham 172 49.3
Brent 150 45.6
Ealing 125 36.4
Redbridge 107 35.4
Hounslow 93 34.5
Harrow 79 31.6
Barking and Dagenham 58 27.4
Waltham Forest 71 25.7
Hillingdon 76 25
Tower Hamlets 72 23.4
Greenwich 66 23.3
Hackney 62 22.3
Local authority Average annual number of people Average annual rate
per 100,000
Haringey 59 21.7
City of London 2 21.2
Southwark 64 20.5
Croydon 74 19.2
Lewisham 55 18.1
Enfield 60 18.1
Merton 36 17.3
Barnet 64 16.6
Lambeth 52 16.1
Hammersmith and Fulham 29 16
Islington 38 16
Camden 39 15.4
Kensington and Chelsea 24 15.1
Wandsworth 49 15
Westminster 37 14.8
Bexley 29 11.8
Sutton 21 10.5
Havering 27 10.4
Kingston upon Thames 11 6.5
Bromley 21 6.4
Richmond upon Thames 12 6
London 1932 21.9

https://www.gov.uk/government/publications/tuberculosis-in-england-annual-report

 

BCG vaccination against TB is currently recommended for all babies born in London. See The London Assembly Health Committee report ‘Tackling TB in London’  which looks into the problems TB poses for the capital and how it can be addressed.  This report states that “NHS London should set out how it plans to ensure universal BCG coverage across all London boroughs by 2017.” Nevertheless, there were only 5 local authorities in London offered a universal BCG vaccination programme in 2018 to 2019, compared with 6 in 2017 to 2018 (Tuberculosis in England: 2019 annual report).

BCG vaccination and the vaccine stock issues in last few years

In the UK, the TB vaccine is not currently part of the NHS routine immunisation schedule in England .  On the NHS, BCG is offered to people who are at higher risk of TB as part of a selective immunisation programme:

Given the high levels of TB in London, there is a strong argument for all babies born in London to be given BCG. However the offer of neonatal BCG across the capital has been patchy.

Are there any side effects?

Immediately after the injection, a raised blister will appear. Within two to six weeks of the injection a small spot will appear. This may be quite sore for a few days, but it should gradually heal if you don’t cover it. It may leave a small scar.
Occasionally, your baby may develop a shallow sore where they had the injection. If this is oozing fluid and needs to be covered, use a dry dressing – never a plaster – until a scab forms. This sore may take as long as several months to heal.

If you are worried or you think the sore has become infected, see your doctor.

There was no scar or blister after my child’s BCG jab. Did it work?

A raised blister will appear in most people vaccinated with BCG, but not everyone. If your child did not have this reaction to the vaccine, it does not mean that they have not responded to it. There’s no need to vaccinate with BCG a second time.

Why is it advised that BCG is always given in the left upper arm?

There is no reason, from a technical or efficacy point of view, that BCG cannot be given in either arm. By convention, it is given in the left upper arm to make it easier to find the scar later in life.

When is it necessary to do a skin test (Mantoux Test) for TB infection before BCG vaccination?

The Mantoux test (also called tuberculin skin test – TST) is used as a screening test for TB infection or disease and as an aid to diagnosis. The local skin reaction to tuberculin purified protein derivative (PPD) injected into the skin is used to assess an individual’s sensitivity to tuberculin protein. The greater the reaction, the more likely it is that an individual is infected or has active TB disease.

A small amount of harmless TB protein is injected under the skin (you can’t catch the disease from this test). The area is checked to see if your body has reacted to the TB protein 48–72 hours later.

We use Tuberculin PPD supplied by AJ Vaccines which is the standard Mantoux test in the UK. 

BCG should not be administered to an individual with a positive Mantoux test – it is unnecessary and may cause a more severe local reaction. Those with a positive Mantoux tuberculin skin test are referred to a TB clinic for assessment of the need for further investigation and treatment.

Mantoux test is necessary prior to BCG vaccination for:
●  all individuals aged six years or over
●  infants and children under six years of age with a history of residence or prolonged stay (more than three months) in a country with an annual TB incidence of 40/100,000 or greater. 
●   those who have had close contact with a person with known TB
●   those who have a family history of TB within the last five years.

MMR vaccination and Mantoux Test can be performed on the same day. However, if a Mantoux Test has already been initiated, then MMR should be delayed until the Mantoux Test has been read unless protection against measles is required urgently. If a child has had a recent MMR, and requires a Mantoux Test, then a four week interval should be observed.

TB screening test (the Mantoux test), if required: £70.

The information in this page are from the Public Health England and  the NHS Choices website.

To book an appointment call: 020 7435 7075